<?php include ("header.php"); ?>
         
            <div id="titre">
                <h2><p align="center"> Signaler Incident </p></h2>
            </div>
            
<?php 

/*
$base = new Connect_bdd('localhost','rtgs','root','');

$req = 'SELECT nom FROM Tunnel';
$tab = $base->select($req);		
	 


while($row = mysql_fetch_array($tab)){

*/
?>	
<form name="input" action="envoisignal.php" method="get">

<table id="tableau" cellspacing="0">
<caption>Veuillez remplir les informations concernant l'incident</caption>
  <p></p>
<script type="text/JavaScript">
			function clearForm()
			{
				
				if(document.getElementById('input').defaultValue == document.getElementById('input').value) { document.getElementById('input').value = ""; }
			}
		</script>
  <tr>
    <td><label for="date">Date :</label><input type="text" name="date" value="	 jj/mm/aaaa" onfocus="clearForm()"> </td>
  </tr>
  
    <tr>
    <td><label for="reference">R&eacute;f&eacute;rence :</label><input type="text"  name="reference"></td>
  </tr>
  
  <tr>
    <td><label for="tunnel">Tunnel :</label><input type="text" name="tunnel"></td>
  </tr>
  
   <tr>
    <td><label for="type">Type Incident :</label><input type="text" name="type"></td>
  </tr>
  
    <tr>
    <td><label for="gravite">Gravit&eacute; :</label><input type="text" name="gravite"></td>
  </tr>
	
	 <tr>
    <td><label for="description">Description :</label><textarea rows="5" cols="50" align="right"  name="description"></textarea> </td> 
  </tr>
</table>
<p></p>
<input type="submit" value="Valider"  align="left" style="height: 26px; width: 141px">&nbsp;&nbsp;&nbsp;
</form>

<?php include("footer.php"); ?>